Left: 46 year-old woman with a polyp seen at routine screening sigmoidoscopy. Although benign in appearance, the polyp contained adenocarcinoma invading the muscularis mucosae. There was no invasion of the stalk, and polypectomy was therefore curative.
Center: 53 year-old woman with rectal bleeding and a family history of colonic carcinoma, with this small (1 cm) benign-appearing polyp which contained adenocarcinoma invading the stalk.
Right: 47 year-old man with severe microcytic anemia and fecal occult blood positivity. This pedunculated tubular adenoma contained adenocarcinoma which did not invade the stalk. Like the two polyps shown at Left and Center, this polyp had a grossly benign appearance.
Left: 59 year-old man with rectal bleeding. Large smooth polyp on a broad stalk, containing invasive adenocarcinoma.
Center: Sessile polyp in the sigmoid colon of a 77 year-old woman with anemia. Although the polyp was moveable and therefore not fixed to the underling colonic wall, it histologically contained submucosal adenocarcinoma.
Right: Same sessile polyp shown in CENTER photo, having been injected submucosally with saline, to elevate it away from the remainder of the colonic wall prior to excision with a snare using electrocautery.
Left: 71 year-old woman undergoing colonoscopy for evaluation of a change in bowel habit with constipation. This 1 cm benign-appearing pedunculated polypoid was excised from the rectosigmoid junction. Histology revealed it to be a tubular adenoma which contained a focus of adenocarcinoma. The resection margin of the stalk was clear, and the cancer was considered to have been completely excised.
Center and Right: 51 year-old woman undergoing colonoscopy for greater than 12 months of hematochezia (rectal bleeding), who had failed to keep her appointment for colonoscopy a year earlier. Exam revealed this 6 mm sessile slightly raised fold in the sigmoid colon, grossly benign in appearance. The polypoid nature was more evident in the image at right. The lesion was excised using a snare and cautery. The pathology report described tubular adenoma with extensive prolapse changes, with desmoplastic features highly suspicious for invasive adenocarcinoma.
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